Provider Demographics
NPI:1366636789
Name:SYLVAN VALLEY OB/GYN, PA
Entity Type:Organization
Organization Name:SYLVAN VALLEY OB/GYN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARMELO
Authorized Official - Middle Name:ABEL
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-884-8860
Mailing Address - Street 1:1 MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BREVARD
Mailing Address - State:NC
Mailing Address - Zip Code:28712-3874
Mailing Address - Country:US
Mailing Address - Phone:828-884-8860
Mailing Address - Fax:828-885-7164
Practice Address - Street 1:1 MEDICAL PARK DR
Practice Address - Street 2:SUITE B
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-3874
Practice Address - Country:US
Practice Address - Phone:828-884-8860
Practice Address - Fax:828-885-7164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC012PROtherBLUE CROSS BLUE SHIELD
NC89012PRMedicaid
NC012PROtherBLUE CROSS BLUE SHIELD
NC2308294Medicare PIN